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01.12.2014 | Ausgabe 12/2014

Surgical Endoscopy 12/2014

Symptomatic and physiologic outcomes one year after peroral esophageal myotomy (POEM) for treatment of achalasia

Zeitschrift:
Surgical Endoscopy > Ausgabe 12/2014
Autoren:
Ezra N. Teitelbaum, Nathaniel J. Soper, Byron F. Santos, Fahd O. Arafat, John E. Pandolfino, Peter J. Kahrilas, Ikuo Hirano, Eric S. Hungness
Wichtige Hinweise
Presented at the SAGES 2014 Annual Meeting, April 2–5, 2014, Salt Lake City, Utah.

Abstract

Background

Peroral esophageal myotomy (POEM) is a new endoscopic operation for the treatment of achalasia. Here, we report 1-year physiologic and symptomatic outcomes following the procedure.

Methods

POEM patients from a single-institution series who were more than 1 year removed from surgery were studied. Eckardt and GerdQ scores were obtained to assess symptoms. High-resolution manometry (HRM), timed barium esophagram (TBE), and upper endoscopy were preformed preoperatively and at 1-year follow-up. 24-h pH monitoring was also performed at 1 year follow-up.

Results

The study population was comprised of 41 patients who were more than 1 year post-POEM. One (2 %) major complication, a contained leak at the EGJ requiring re-operation, and 7 (17 %) minor complications occurred. Mean length of stay was 1.4 days. At mean 15-month follow-up, Eckardt scores improved from pre-POEM 7 ± 2 to post-POEM 1 ± 2, (scale 0–12, p < .001), and 92 % of patients achieved treatment success (Eckardt score <4). Two of the three treatment failures in the series occurred in the initial three patients. 15 % of patients had post-POEM symptoms suggestive of gastroesophageal reflux (GerdQ >7). On follow-up HRM, esophagogastric junction integrated relaxation pressure was decreased significantly (pre-POEM 28 ± 12 mmHg vs. post-POEM 11 ± 4 mmHg, p < .001), and 47 % of patients studied had partial recovery of peristalsis. On follow-up TBE, barium column heights were decreased compared with preoperatively. Postoperative upper endoscopy revealed esophagitis in 59 % of patients (11 LA Grade A, 2 LA Grade D). However, of the 13 24-h pH monitoring studies performed, only four (31 %) demonstrated pathologic esophageal acid exposure.

Conclusions

In this series, POEM resulted in greater than 90 % symptomatic treatment success at mean 15-month follow-up. Rates of iatrogenic gastroesophageal reflux, as measured both by symptoms and 24-h pH monitoring, appeared to be on par with recent studies of patients undergoing laparoscopic Heller myotomy and pneumatic dilation.

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